Lieu T A, Lundstrom R J, Ray G T, Fireman B H, Gurley R J, Parmley W W
Division of Research, Permanente Medical Group, Inc., Oakland, California 94611, USA.
J Am Coll Cardiol. 1996 Oct;28(4):882-9. doi: 10.1016/s0735-1097(96)00237-9.
We sought to evaluate the initial economic cost of primary angioplasty for acute myocardial infarction under varying assumptions about whether a cardiac catheterization laboratory exists, whether services are provided during night and weekend hours and how cardiovascular surgical backup is arranged.
Primary angioplasty for acute myocardial infarction has resulted in clinical outcomes superior or equal to those obtained with thrombolysis in recent studies, but its future implementation depends greatly on its cost and cost-effectiveness. There is a gap in knowledge about the true economic costs of this procedure, and understanding costs under a variety of hypothetic scenarios is important in planning whether and how the procedure should be offered to broad groups of patients.
A generalizable spreadsheet model was constructed to calculate the cost of primary angioplasty at a single hospital with assumptions based on data from a large nonprofit health maintenance organization (Kaiser Permanente). The following baseline assumptions were made: 1) A total of 200 patients with myocardial infarction presented to the hospital each year; 2) primary angioplasty was offered for 10 years; 3) the hospital had a cardiac catheterization laboratory; 4) costs of night call for technical personnel and cardiovascular surgical backup were already covered. Other scenarios were modeled to represent different assumptions about existing resources.
Under the baseline assumptions, primary angioplasty cost $1,597/procedure. If night call for technical personnel were a new expense, the average cost would be > or = $3,206. If a new cardiac catheterization laboratory needed to be built, costs would range from $3,866 to $14,339/procedure, depending on how cardiovascular surgical backup was provided. Results were sensitive to assumptions about the annual volume of myocardial infarctions, the number of years the procedure was offered and the costs of labor, construction and equipment.
The initial cost of providing primary angioplasty for acute myocardial infarction varies greatly, depending on the setting in which it is provided. To provide information for clinical policy decisions, a cost-effectiveness model is needed that combines these initial costs with data on survival, quality of life and rates and costs of subsequent cardiac procedures.
我们试图评估在关于是否存在心脏导管室、夜间和周末是否提供服务以及如何安排心血管外科后备支持等不同假设下，急性心肌梗死直接血管成形术的初始经济成本。
在近期研究中，急性心肌梗死直接血管成形术的临床结果优于或等同于溶栓治疗，但该技术未来的应用在很大程度上取决于其成本和成本效益。对于该手术真正的经济成本，目前存在认识差距，了解各种假设情况下的成本对于规划是否以及如何向广大患者群体提供该手术非常重要。
构建了一个通用的电子表格模型，根据一家大型非营利性健康维护组织（凯撒医疗集团）的数据进行假设，计算一家医院直接血管成形术的成本。做出了以下基线假设：1）每年共有200例心肌梗死患者到该医院就诊；2）直接血管成形术实施10年；3）医院有心脏导管室；4）技术人员夜间值班费用和心血管外科后备支持费用已涵盖。还模拟了其他情景以代表关于现有资源的不同假设。
在基线假设下，直接血管成形术的成本为每例1597美元。如果技术人员夜间值班是一项新费用，平均成本将≥3206美元。如果需要新建一个心脏导管室，根据心血管外科后备支持的提供方式，成本将在每例3866美元至14339美元之间。结果对心肌梗死年例数、手术实施年限以及劳动力、建设和设备成本的假设很敏感。
急性心肌梗死直接血管成形术的初始成本差异很大，这取决于实施手术的环境。为了为临床政策决策提供信息，需要一个成本效益模型，将这些初始成本与生存、生活质量以及后续心脏手术的发生率和成本数据结合起来。
